{[ promptMessage ]}

Bookmark it

{[ promptMessage ]}

inoperable - Inoperable NSCLC Controversies in Management...

Info iconThis preview shows pages 1–4. Sign up to view the full content.

View Full Document Right Arrow Icon
1 Controversies in Management of Inoperable NSCLC Inoperable NSCLC Introduction: It is difficult to overemphasize the magnitude of lung cancer as Public Health Problem in our society . - In US, Lung cancer accounts for 1\3 of all cancer related deaths. - More women die each year of lung cancer than breast cancer . - Lung cancer is notoriously lethal. - 85.90% of patients who develop the disease will ultimately succumb as a result . - Untreated, medium survival of patients with metastatic NSCLC is only 4-5 months with 1 year survival rate of only 10 % . The prognosis for Pts diagnosed with lung cancer remains poor. However, this disease remains a major focus of research & some exciting advances offer significant hope. Specific treatment recommendations are guided by (1) Histologic type of tumor (2) stage of disease (3) Pts Performance status The initial goal in managing Pts. with NSCLC is to determine whether a Pt. is 1. Operable : Pt. Will survive Sx with an acceptable risk for morbidity & mortality. 2. Cancer is resectable: Lesion is technically removable & will result in improved prognosis.
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
2 Pts. Operability is usually determined by cardiovascular exam; spirometry and ABG. Resectability is determined by staging. Stage III B & IV usually do not respond to resection. For these stages a combined multimodality approach should be considered. CT Vs No CT - There have been 10 RCT comparing Platinum based CT compared with Best supportive care (BSC) includes antitussives/O 2 /analgesics/RT when indicated. - Cullen et al, 1999 (J Clin Oncol) - Other studies also showed better survival time in the treatment arm. CT N=175 (Mitomycin / Ifosfamide / Cisplatin) BSC N=176 PS=0-1 in 62% (P=0.03) 4.8 mths. 6.7 mths. Survival time - Souquet et al, 1993 (Meta - analysis of Polychemotherapy in advanced NSCLC) Lancet. No. of Pts : 706 End Point : No of Deaths at 3,6,9,12,18 months Conclusion : Mortality for upto 6 months. - NSCLC Collaborative Group, 1995 [CT in NSCLC, meta-analysis using updated data on individual Pts from 52 RCT] BMJ No. of Pts : 1190 Risk of Death : 27% Reduction in the risk of death in CT treated Pts. In conclusion, evidence from RCT & four separate meta-analysis support the fact that Platinum based CT improves survival in Pts. with advanced NSCLC. Do New Agents in Combination with Platinum Based Agents Improve Survival over Second-Gen. Platinum based Regimens The first of new drugs to be studied in RCT was vinorelbine. Le Chevalier T et al. (J Clin Oncol 1994) - This French study compared Cisplatin + Vindesine with Vinorelbine alone or Vinorelbine + Cisplatin.
Background image of page 2
3 - Cisplatin/Vinorelbine had median Survival of 40 wks. Compared with cisplatin/vindesine which had 32 wks survival. - Bonomi P et al [J Clin Oncol, 2000] - Cisplatin/Paclitaxel Vs Cisplatin/Etoposide Median survival 10 mths. 7.7 mths. - Niho S et al. [Proc Am Soc Clin Oncol, 1999] Cisplatin/Vindesine Vs Cisplatin/Irinotecan Median survival 52 wks. 47 wks.
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 4
This is the end of the preview. Sign up to access the rest of the document.

{[ snackBarMessage ]}